Assess Patient Safety Research Articles

Patient safety culture assessment before and after safety huddle implementation.

To identify whether safety huddle implementation enabled a change in patient safety culture. Quasi-experimental research that assessed patient safety culture before and after safety huddle implementation. The study revealed that 53.98% completed the two safety culture assessments, with 60.1% adherence from the nursing team, with a statistically significant difference in the second assessment regarding perception of patient safety and adverse events notified (p < 0.00). Regarding good practice indicators, a statistically significant difference (p < 0.00) was observed in item 43 and improvement in almost all dimensions in the second safety culture assessment. The huddles totaled 105 days, with 100% adherence from the nursing team. Regarding checklist items, all presented satisfactory responses (above 50%). Safety huddles proved to be an effective tool for communication between healthcare professionals and managers, demonstrating positive impacts on good practice indicators and most safety culture dimensions.

Development of the Korean Patient Safety Incidents Code Classification System.

Attempts to understand patient safety using administrative data in Korea have been rare. This study develops a Korean patient safety incident code classification system and identifies its characteristics to boost diagnosis code usage for assessing patient safety. Based on existing literature, we selected Korean Standard Classification of Diseases 7 codes for characterizing patient safety incidents using diagnosis codes. We conducted 2 rounds of review to evaluate the codes applicability to different patient safety incidents using the Delphi method. The verified diagnosis codes were then classified by incident type. Of the 54,259 Korean Standard Classification of Diseases 7 codes, 4509 were applicable for Korean patients, which were divided into 2435 code groups and 2074 candidate groups. The codes were classified into 6 categories (diagnosis, medication, patient care, operation or procedure, infection related, and other) and then further classified into 35 subcategories. The major categories of patient safety incidents, in the order of frequency, involved medication, fluid and blood related (1719, 38.1%), operation and procedure related (1339, 29.7%), and patient care related (991, 22.0%). Meanwhile, there were only 2 codes related to diagnosis. Our study provides a basis for estimating patient safety incidents using diagnosis codes. We suggest that gradually increasing the utilization and accuracy of the patient safety incident codes will help develop effective patient safety indicators in Korea similar to other countries. Moreover, clinicians are also needed to be aware of using the developed code classification system.

Nurses' Perceptions of Patient Safety Culture During the Pandemic in Covid-19 Referral Hospitals

Patient safety culture is essential in creating a safe and healthy hospital environment. This study aims to portray nurses' perceptions of patient safety culture during the Pandemic in COVID-19 Referral Hospitals. This paper was a descriptive study. The population was nurses working in inpatient, Covid-19 isolation, intensive, and emergency rooms. In addition, the sample was 268 nurses with a stratified random sampling. Data collection used a questionnaire using Google Forms. It consisted of the demographic characteristics of respondents (name, gender, age, marital status, working time, education, nurse position, levels of nursing, and patient safety training) also nurses' perception of patient safety culture. The Hospital Survey on Patient Safety Culture (HSOPC) was an instrument to assess patient safety culture. Data analysis used IBM SPSS Statistics version 22.0 to describe the mean, median, minimum, and maximum values and presentation. Results showed that the mean patient safety culture among nurses in COVID-19 referral hospitals was 147.09 (62.55%). In addition, the lowest dimension of patient safety culture was feedback and communication (31.75%), while the highest was an organizational improvement (73.16%). Thus, the patient safety culture in the COVID-19 referral hospital still needed improvement. A good patient safety culture can increase patient safety and the quality of health services. Therefore, hospital management should optimize all dimensions of patient safety culture to ensure patient safety. Future research could explore predisposing factors of patient safety culture

Implementation of radio-frequency identification technology to optimize medication inventory management in the intraoperative setting.

Manual restocking and tracking of noncontrolled medications in anesthesia workstations (AWSs) is complicated and time intensive, provides several opportunities for error, and lacks perpetual inventory transparency regarding expiration and lot number. This pre-post study assessed the impact of radio-frequency identification (RFID) technology on restocking of noncontrolled medications in AWSs in relation to workflow, improved patient safety due to reduced restocking errors, and restocking accuracy and efficiency, as well as the estimated costs of on-site medication RFID tagging versus purchase of pretagged products. Pre- and postimplementation process steps were mapped. Randomized AWS tray audits were conducted to assess patient safety, and AWS tray restocking efficiency was measured through stopwatch studies. Time and costs associated with purchase of manufacturer RFID tagged medications versus manually tagging medications on-site were estimated. Pre-post comparisons were completed using descriptive statistics. Prior to implementation, manual AWS restocking took a mean (SD) of 37.9 (24.7) seconds (range, 4.6-135.9 seconds), compared to 145.9 (50.6) seconds (range, 43.4-314.3 seconds) after implementation. The automated workflow took technicians an average of 108 seconds (1.8 minutes) longer than the baseline time. However, restocking errors were reduced by 64.7% and outdated and missing medications eliminated. Manually applying tags to packages containing 25 vials took a mean (SD) of 174.8 (19.8) seconds (range, 131-218 seconds) for smaller vials, compared to 128.1 (21.6) seconds (range, 102-166 seconds) for larger vials. Manual tag application was also more expensive than purchasing of pretagged vials. Automated RFID technology for AWS restocking decreased restocking errors but increased the length of time to complete the restocking process.

Incidence of unplanned intensive care unit admission following surgery and associated factors in Amhara regional state hospitals

Unplanned postoperative critical care admission poses a potential risk to patients and places unanticipated pressure on clinical services and it has become an important parameter to assess patient safety in perioperative services. This study was aimed to determine the incidence of unplanned intensive care unit admission following surgery and the associated factors. A multi-center cross-sectional study was conducted on postoperative patients admitted to the ICU of three hospitals located in the Amhara region. Data were collected via a structured survey tool and analyzed using SPSS version 23 software with binary logistic regression analysis. The statistical significance to identify patient, anesthetic and surgical related factors in the preoperative, intraoperative, and postoperative period was < 0.05 for multivariable regression with a 95% confidence interval. Predominantly patients were admitted to the ICU in an unplanned manner. ASA status, preoperative hemoglobin (Hgb) level, intraoperative estimated blood loss, and adverse events occurring in the operating room were significantly associated with intensive care unit admission following surgery. Patients who had a low preoperative Hgb value were 35.1 times more likely to be admitted to the intensive care unit in an unplanned manner compared with their counterparts [(Adjust odds ratio (AOR) 35.16; CI 12.82, 96.44)]. Patients with ASA II and III were 19.4 and 16.2 times more likely to be admitted to ICU in an unplanned way compared to patients who had ASA I physical status [(AOR 51.79; CI 8.28, 323.94) (AOR 67.8 CI 14.68, 313.53)]. Unplanned ICU admission after surgery was high in this study, suggesting poor perioperative planning, risk stratification, and optimization of patients.

Assessment of patient safety culture among the staff of the University Hospital for Gynecology and Obstetrics in Alexandria, Egypt

BackgroundPatient safety (PS) is a fundamental component of healthcare quality. Patient Safety Culture (PSC) assessment provides an organization with insight of perceptions and attitudes of its staff related to patient safety. In addition, it is meant to improve performance rather than blaming individuals. This study aimed to assess patient safety culture from the health care staff perspective in El-Shatby University Hospital for Gynecology and Obstetrics.MethodsA descriptive cross-sectional study was conducted. The study was conducted at El-Shatby University Hospital for Gynecology and Obstetrics from November 2020 to January 2021. The target participants were assistant lecturers, residents, and head nurses in charge during the field study period. The number of potential participants who fulfilled the inclusion criteria (in charge during the period of data collection and working in the hospital for more than 3 months) was 83; the twelve participants who participated in the pilot study were excluded. The total number of participants who agreed to participate in the study was 66 participants (38 residents, 18 assistant lecturers, and 10 head nurses) out of 71 potential participants representing a 92.9% response rate. A structured self-administered questionnaire format adapted from Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was distributed anonymously to the participants. The questionnaire has 42 items measuring twelve patient safety culture dimensions: teamwork within the unit, supervisors’ expectations and actions to promote patient safety, feedback and communication about error, organizational learning, communication openness, overall perception of patient safety, hands-off and transitions, teamwork across units, frequency of events reported, management support for patient safety, staffing, and management support for patient safety. Except for two items that are responded on a five-point frequency scale (never, rarely, sometimes, most of the time, and always) the majority of patient safety culture questions are answered on a five-point agreement scale (strongly disagree, disagree, neutral, agree, and strongly agree), with a higher score indicating a more favorable attitude toward patient safety.ResultsThe overall average positive percent score was 45.4%. Average positive response percentages to individual items ranged from 28.8 to 81.8%. No domain had an average positive percent score of more than 75%. Out of the twelve dimensions of patient safety culture included in the HSOPSC questionnaire, “the teamwork within unit” domain had the highest average positive percent score (62.1%) among all participants. On the other hand, the “Non-punitive response to error” domain had the lowest score (18.9%). More than half (57.6%) of the participants rated patient’s safety at the hospital as acceptable.ConclusionInvesting in practices that strengthen patient safety is crucial if the hospital is to improve overall performance and quality of services. The present study displays a frail patient safety culture (PSC) in the majority of the domains. All the domains should be considered of high priority focused areas for remark and reformative tasks. Continuous training programs of the staff on patient safety to improve their perception of safety culture are necessary. All PSC composites need improvement starting with regular assessment of PSC along with continuous monitoring and increasing the healthcare providers’ awareness of demanded PSC.

Studying the IVF Laboratory Performance Indicators the Vienna Consensus 2017 for the High Institute According to Diagnosis and Assisted Reproductive for Infertility Technologies, Al-Nahrain University, Iraq

Background: Performance indicators are used to assess patient safety, efficacy, equity, patient-centeredness, punctuality, and efficiency. The benchmark values for each Key Performance Indicator are aspirational values, and the minimum performance level values are the number of fertilized oocytes on Day 1 and the Normal Fertilization Rate, respectively (presence of 2Pro Nucleus and 2Polar Body measured at 17 h post-injection) as a Failed fertilization rate is calculated as the proportion of IVF cycles (excluding cycles with intracytoplasmic injection) on Day 1 (17 hours after insemination) with no signs of pregnancy.&#x0D; During fertilization (i.e., 0 oocytes with 2Pro Nucleus). The percentage of zygotes on Day 2 (44 hours after insemination) is known as the cleavage rate, and it can suggest an issue with sperm quality (sperm function, oocyte activation, and gamete receptors), sperm processing, or the quantity of spermatozoa used for insemination. which cleaves to create embryos. The percentage of cleaved embryos per successfully fertilized egg that are at the 4-cell stage on Day 2 (44 hours post-insemination) or at the 8-cell stage on Day 3 (68 hours post-insemination) is known as the embryo development rate. This evaluates the viability and quality of the embryos as well as the capacity of the culture system to promote cleavage at the necessary stages. The critical factor is the proportion of blastocysts observed at 116 hours after insemination as a function of the number of correctly fertilized oocytes. Measures of performance blastocyst development rate. The viability of the embryo as well as the culture system's capacity to support blastocyst formation from fertilized oocytes (i.e., the formation of an intracellular mass and a blastocoele cavity) are both determined by this factor. It should be noted that this phrase only considers blastocyst formation and not blastocyst stage or quality. The damage rate is the proportion of oocytes that are injured or have deteriorated by the time of fertilization assessment on Day 1 as a result of the intracytoplasmic injection. The percentage of biopsied and tubed/fixed samples where DNA is found represents the success rate of the biopsy. It serves as a gauge of the embryologists' ability to transfer biopsied samples to test tubes, as shown by successful DNA amplification. The number of gestational sacs divided by the total number of transplanted embryos is how one calculates the implantation rate, which is dependent on the cleavage stage. By dividing the number of gestational sacs by the total number of transplanted blastocysts, the implantation KPI (blastocyst stage) is calculated.

Assessing patient safety culture in obstetrics ward: A pilot study using a modified Manchester Patient Safety Framework in China.

The primary objective of this study was to assess the patient safety culture in a general hospital in Shanghai, China, through a modified Manchester Patient Safety Framework (MaPSaF). This study has a qualitative interview design. Data were collected through group interviews and analyses performed through content analysis. The MaPSaF was translated into Chinese and used to assess the patient safety culture in a large general hospital in Shanghai, China. Group interviews using the MaPSaF were conducted with 15 nurses in the obstetric ward. Participants rated their safety practice individually on each of the nine MaPSaF safety culture dimensions. The dimensions and scores were then collectively discussed and a practice-wide consensus score for each dimension was agreed. Discussions were recorded, transcribed and analysed to assess patient safety in the obstetric ward. It took about 2 hr to complete the discussion focusing on patients' safety employing the MaPSaF. Most participants recognized the process as acceptable and useful. The MaPSaF directed team discussion about patient safety issues and facilitated communication, prompting some practice changes. All participants responded positively to the discussion and perceived MaPSaF as a good safety culture assessment tool, with clear, comprehensive and understandable entries. The process demonstrated that the department of obstetrics in the hospital already had a positive patient safety culture, but certain areas were highlighted as still needing improvement. Based on participants' positive experience and perception of the MaPSaF, it can be concluded that there is potential benefit in its adaptation and use in obstetrics wards of Chinese hospitals. The MaPSaF has the potential to strengthen existing safety cultures and improve general safety through collaborative measures.

Visible Light Navigation in Spine Surgery: My Experience With My First 150 Cases.

Technological innovations have revolutionized spine surgery. There are a variety of image-guidance systems and navigation options including robotics and augmented reality. These devices provide the opportunity for increased safety and efficiency in surgery. There are advantages and disadvantages to each approach to spinal instrumentation. In this article, the author reviews his experience with visible light navigation using a 7-dimensional (7D) machine vision system and reviews the use, strengths, and weaknesses of this method of spinal navigation.This study is a retrospective cohort investigation of 150 consecutive patients who underwent spinal instrumentation placement utilizing visible light navigation. The objective was to determine the utility of the navigation system and its strengths and weaknesses as well as to assess patient safety when screw placement is performed with visible light navigation in place of C-arm localization. Visible light navigation was found to be effective and efficient, enhancing screw placement and decreasing surgical time. There were no complications in this series of patients and no instances of symptomatic screw malposition.

Patient safety culture in primary health care: Medical office survey on patient safety culture in a Brazilian family health strategy setting.

Study objectivesTo assess the patient safety culture in Primary Health Care (PHC) setting after the transition to the Family Health Strategy (FHS) model in a Brazilian metropolitan area and compare the results between the categories of health care professionals.MethodsA cross-sectional study including 246 workers from primary health care services in Federal District, Brazil. Data collection took place from October to December 2019 through the Medical Office Survey on Patient Safety Culture (MOSPSC) application. Patient safety culture was considered positive when the score was above 60%. For comparisons between the categories of health care professionals’, the ANOVA and Kruskal-Wallis test were used for composite percent positive scores, and Pearson’s chi-square or Fishers exact test for frequency and percentage of positive responses.ResultsThe overall MOSPSC composite percent positive score was 49.9%. Among the 12 dimensions, only three showed a positive patient safety culture: Teamwork (73.1%), Organizational learning (62.9%), and Patient care tracking/follow-up (60.1%). The percentage of positive responses on overall quality assessment (78.1%) and overall patient safety assessment (78.0%) showed a positive evaluation. There was no significant difference in the composite percent positive score of overall MOSPSC (p = 0.135) and the percentage of positive responses on overall patient safety assessment (p = 0.156) between the categories of health care professionals. Overall quality assessment showed a significant difference between job roles (p < 0.001), in which nursing /health care technicians showed a significantly lower score than other job roles.ConclusionThe patient safety culture assessment showed a weakness in the patient safety in the PHC services. The MOSPSC and nine of its dimensions presented a negative safety culture assessment, regardless of the high scores in the overall patient safety and quality assessments.

Disparities in Adverse Event Reporting for Hospitalized Children.

Hospitals rely on voluntary event reporting (VER) for adverse event (AE) identification, although it captures fewer events than a trigger tool, such as Global Assessment of Pediatric Patient Safety (GAPPS). Medical providers exhibit bias based on patient weight status, race, and English proficiency. We compared the AE rate identified by VER with that identified using the GAPPS between hospitalized children by weight category, race, and English proficiency. We identified a cohort of patients 2 years to younger than 18 years consecutively discharged from an academic children's hospital between June and October 2018. We collected data on patient weight status from age, sex, height, and weight, race/ethnicity by self-report, and limited English proficiency by record of interpreter use. We reviewed each chart with the GAPPS to identify AEs and reviewed VER entries for each encounter. We calculated an AE rate per 1000 patient-days using each method and compared these using analysis of variance. We reviewed 834 encounters in 680 subjects; 262 (38.5%) had overweight or obesity, 144 (21.2%) identified as Black, and 112 (16.5%) identified as Hispanic; 82 (9.8%) of encounters involved an interpreter. We identified 288 total AEs, 270 (93.8%) by the GAPPS and 18 (6.3%) by VER. A disparity in AE reporting was found for children with limited English proficiency, with fewer AEs by VER ( P = 0.03) compared with no difference in AEs by GAPPS. No disparities were found by weight category or race. Voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.

Assessing Patient Safety Culture among Healthcare Providers at a Tertiary Care Hospital

Background: Patient safety is significant to improve the quality care in health-care organisations; hence, assessment of patient safety culture is the paramount need of the h. However, in middle- and low-income countries, the burden of patient safety is vital as the healthcare-related injuries and deaths are increasing, this is global health concern. The awareness of measuring patient safety culture needs to be improved in low- and middle-income countries and this can help in evaluating the culture and formulating interventions and also achieving the accreditation standards. National Accreditation Board for Hospitals (NABH) with a focus of patient safety has contributed largely in the quality of health care in Indian hospitals and witnessed progress and improvement. However, the challenges in a country like India are large and complex and need to be addressed systematically beyond the meeting accreditation standards. Aim: The aim of this study was to assess the level of perception among the healthcare providers at a tertiary care hospital. Methods: Cross-sectional study was conducted using The Hospital Survey on Patient Safety culture (HSOPSC v−1) tool to assess the level of perception of patient safety culture among healthcare providers. The survey was conducted among 400 respondents of tertiary care hospital, Bangalore, Karnataka (India) through a structured, open- and close-ended questionnaire. Participants were selected through nonprobability random sampling. Collected data were analyzed through composite scores, Chi-square, and Man–Whitney U-test for test. Results: The present study showed a highest positive response in teamwork within the units and the least in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses in many studies including the present study (41.13%). For the data analyzed above regarding the perception of patient safety culture dimensions among the healthcare professionals, it was seen that there was a statistically significant association (0.0026) between the two variables that perception and safety culture existing in the hospital. Conclusion: After comparing between experience and level of perception among healthcare providers, it was concluded that the Chi-square value is 0.04 which is statistically significant and there is a significant association between positions and level of perception. Therefore, our study indicates that there is a high need to develop strategies related to certain safety domains that urgently need improvement in this hospital.

Assessment of postoperative patient handover practice and safety at post anesthesia care unit of Dilla University Referral Hospital, Ethiopia: A cross-sectional study

IntroductionGood handover creates a common understanding of responsibility and patients’ status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams. MethodologyA descriptive cross-sectional study was conducted at post anesthesia care unit of Dilla University Referral Hospital from October 1 to November 30, 2020. To conduct the study, consecutively selected 208 handovers of patients from operation theatre (OT) to PACU were assessed. A checklist was developed based on a combination of criteria adopted from the Australian Medical Association 2006 and British Doctors Committee 2004. It was pilot tested and changes were made before the actual data collection. ResultOur study found that the postoperative patient handover practice among professionals was poor (below 50%) in the areas of patients’ full name, age, medical registration number (MRN), ASA class, allergic history, medical history, baseline vital signs, preoperative diagnosis and surgical procedure performed. Our study also found poor postoperative hand overing regarding the intraoperative blood loss 9.6%, intraoperative clinical incidents 5.3%, recovery condition 7.2%, postoperative analgesia plan 18.8%, and post operative antibiotic plan 8.2%. Whereas, type of anesthesia 81.3%, intraoperative vital signs 80.8%, and intraoperative analgesia used 79.8%, intraoperative fluid management 80.8% were among the indicators with >50% completion rate. Conclusion and recommendationOur study found a poor practice of patient handover regarding sociodemographic and preoperative profile, anesthesia, surgery and other necessary information. We believe standardizing this process and providing training will improve the quality of postoperative handovers and the safety of patients during this critical period.

Psychometric properties of the full and short version Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument: a cross-sectional study assessing patient safety culture in Norwegian homecare services

ObjectivesMeasure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on...

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

BackgroundPatient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.MethodsA cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.ResultsThe results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p < 0.05).ConclusionsThis is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

Clinical Reasoning Behind Antibiotic Use in PICUs: A Qualitative Study.

To describe the reasoning processes used by pediatric intensivists to make antibiotic-related decisions. Grounded theory qualitative study. Three Canadian university-affiliated tertiary medical, surgical, and cardiac PICUs. Twenty-one PICU physicians. None. We conducted field observation during morning rounds followed by semistructured interviews with participants to examine the clinical reasoning behind antibiotic-related decisions (starting/stopping antibiotics, or treatment duration) made for patients with a suspected/proven bacterial infection. We used a grounded theory approach for data collection and analysis. Thematic saturation was reached after 21 interviews. Of the 21 participants, 10 (48%) were female, 15 (71%) were PICU attending staff, and 10 (48%) had greater than 10 years in clinical practice. Initial clinical reasoning involves using an analytical approach to determine the likelihood of bacterial infection. In case of uncertainty, an assessment of patient safety is performed, which partly overlaps with the use of intuitive clinical reasoning. Finally, if uncertainty remains, physicians tend to consult infectious diseases experts. Factors that override this clinical reasoning process include disease severity, pressure from consultants, and the tendency to continue antibiotic treatment initiated by colleagues. Antibiotic-related decisions for critically ill children are complex, and pediatric intensivists use several clinical reasoning strategies to decrease the uncertainty around the bacterial etiology of infections. However, disease severity and patient safety concerns may overrule decisions based on clinical evidence and lead to antibiotic use. Several cognitive biases were identified in the clinical reasoning processes.

Assessing patient safety culture in 15 intensive care units: a mixed-methods study

BackgroundWithin hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients’ fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach.MethodsA cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling.ResultsAll of the PSC dimensions had a score of less than 50%. The developed dimension was ‘teamwork within units’ (48.8%). The less developed dimensions were ‘frequency of event reporting’ (20.8%), ‘communication openness’ (22.2%) and ‘non-punitive response to error’ (19.7%). Interviews’ thematic analysis revealed four main themes including “Hospital management/system failure”, “Teamwork and communication”, “Error management” and “Working conditions”.ConclusionThis research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.

Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?

Mental health lacks robust measures to assess patient safety. Unplanned discharge is common in mental health populations and associated with poor outcomes. Clarifying whether unplanned discharge varies across settings may highlight the need to develop measures to reduce harms associated with this event. Unplanned discharge rates were compared across the Department of Veterans Affairs' acute inpatient and residential mental health treatment settings from 2009 to 2019. Logistic regression was used to create facility-level, adjusted unplanned discharge rates stratified by setting. Results were described using central tendency. Among 847,661 acute inpatient discharges, the mean unplanned discharge rate was 3.3% (range, 0%-18%). Among 358,117 residential discharges, the mean unplanned discharge rate was 17.9% (range, 1%-48.3%). Unplanned discharge is a marked problem in mental health, with large variation across treatment settings. Unplanned discharge should be measured as part of patient safety efforts.

Assessing Patient Safety Culture in United States Hospitals.

A positive patient safety culture plays a major role in reducing medical errors and increasing productivity among healthcare staff. Furthermore, understanding staff perceptions of patient safety culture and effective patient safety factors is a first step toward enhancing quality of care and patient safety. The objectives of this study were to assess patient safety culture in hospitals in the United States and to investigate the effects of hospital and respondent characteristics on perceived patient safety culture. An analysis of 67,010 respondents in the 2018 Agency for Healthcare Research and Quality (AHRQ) comparative database was conducted with partial least squares structural equation modeling (PLS-SEM). The results revealed that perceptions of patient safety culture had a positive influence on the overall perceptions of patient safety and frequency of event reporting. Moreover, staff position, teaching status, and geographic region were found to have varying influence on the patient safety culture, overall perceptions of patient safety, and frequency of event reporting.

The incidence of iatrogenic deaths in the Finnish cause-of-death statistics; a retrospective study

PurposeAn adverse event in health care leading to death is a significant event when assessing patient safety. This study was designed in order to assess, how many iatrogenic deaths are registered in Finland annually, and what type of treatment they are mostly related to. MethodsMaterial was collected using cause of death-statistics that includes “manner of death”-classification in Finland in 2014–2015. ResultsThere were 350 cases that met the criteria of the study. In a majority of the cases (264, 75%), a medico-legal autopsy was performed. This represents only 1.4% of all medicolegal autopsies during the study period in Finland. The cases were most often related to medication (30%) or known high-risk procedures such as gastrointestinal surgery (23%) and cardiothoracic surgery (11%). Only 12% of the cases had no prior significant medical history. Patient characteristics were somewhat different among the surgical disciplines, probably reflecting treatment practices. ConclusionDeaths that are classified as iatrogenic are mostly related to known high-risk surgery or medication. Further studies are needed to assess the true incidence of malpractice among this material.